The detrimental effect of cigarette smoking on flap survival: an experimental study in the rat

Cigarette smoking is commonly prohibited after surgery involving flaps. This admonition against smoking has been justified on the theoretical grounds that flap survival could be decreased by the cutaneous vasoconstriction and increased platelet aggregation produced by smoking cigarettes. A smoke chamber was constructed to evaluate directly the effect of intermittent cigarette smoke exposure on the survival of a McFarlane flap on the dorsum of a rat. The O2, CO2 and temperature were monitored in the chamber during smoke exposures and consistently approximated values seen in room air. Average flap survival at 7 days in control rats not exposed to cigarette smoke was 75.2% while flap survival decreased to 40.1% in rats intermittently exposed to cigarette smoke. The difference was statistically significant (p less than 0.01). Changes in carboxyhaemoglobin levels similar to those observed in human smokers were also found in the smoke-exposed rats. These findings support the concept that post-operative cigarette smoking is detrimental to flap survival.